Bronchoalveolar lavage versus bolus administration of lucinactant, a synthetic surfactant in meconium aspiration in newborn lambs.

Abstract

This study was designed to study effects of lung lavage versus the classical bolus instillation with a peptide-based synthetic surfactant (lucinactant) in a model of Meconium Aspiration Syndrome (MAS). Eighteen newborn lambs received meconium and were randomized to: the experimental meconium installation (eMAS) group-lambs with eMAS kept on conventional mechanical ventilation (control); the SF-Bolus group-eMAS receiving a lucinactant bolus (30 mg/ml); or the D-SF-Lavage group-eMAS treated with dilute lucinactant bronchoalveolar lavage (10 mg/ml). Systemic and pulmonary arterial pressures, blood gases, and pulmonary mechanics were recorded for 180 min. In addition, the intrapulmonary distribution of the lucinactant was determined using dye-labeled microspheres. Following meconium instillation, severe hypoxia, hypercapnia, acidosis, and pulmonary hypertension developed, and dynamic compliance decreased (50% from baseline). After lung lavage with dilute lucinactant, gas exchange significantly improved versus bolus instillation (P < 0.05). Further, only in the lavage group did pulmonary arterial pressure return to basal values and dynamic compliance significantly increased. Both lung lavage and bolus techniques for the administration of lucinactant resulted in a non-uniform lung distribution. In conclusion, in newborn lambs with respiratory failure and pulmonary hypertension induced by meconium, lung lavage with dilute lucinactant seems to be an effective and safe alternative for treatment for MAS.

• Authors: C Rey-Santano, F J Alvarez-Diaz, V Mielgo, X Murgia, H Lafuente, E Ruiz-Del-Yerro, A Valls-I-Soler, E Gastiasoro
• Journal: Pediatric pulmonology (Pediatr Pulmonol) Vol. 46 Issue 10 Pg. 991-9 (Oct 2011) ISSN: 1099-0496 [Electronic] United States
• PMID: 21520434 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Wiley-Liss, Inc.

Chemical References

• Drug Combinations
• Fatty Alcohols
• Phosphatidylglycerols
• Proteins
• Pulmonary Surfactants
• lucinactant

Topics

• Animals
• Animals, Newborn
• Blood Pressure
• Bronchoalveolar Lavage
• Disease Models, Animal
• Drug Combinations
• Fatty Alcohols (administration & dosage)
• Humans
• Infant, Newborn
• Meconium Aspiration Syndrome (physiopathology, therapy)
• Phosphatidylglycerols (administration & dosage)
• Proteins (administration & dosage)
• Pulmonary Surfactants (administration & dosage)
• Respiratory Function Tests
• Sheep